What We Don't Talk About When We Talk About Love

Rather than roses, chocolates and glittering jewels, I’d like to discuss, today being Valentine’s Day, the other side of contemporary dating life: blisters, warts, shame and embarrassment. In a culture that glamorizes sexuality at every opportunity, the unpleasant outcomes of active sexuality do not receive the necessary attention it deserves. Sexually transmitted diseases (STD) and infections (STI), which are solely medical conditions, suggest promiscuity, immorality, uncleanness and other equally unsavory connotations. Because of these culturally objectionable associations, many people newly diagnosed with a STI or STD, confine it to themselves after a hasty conversation with their doctor. And, of course, there is the Internet, the vast public forum for both pertinent medical information, and misinformation and opinions that perpetuate the stigma around sexual illness and sexuality. 

Shame and guilt, when not named and brought out to air, fester and gain momentum and significance. Repression and denial may be effective for a short time, but, eventually, the emotional impact requires processing; otherwise, the original shame and guilt will seep into other parts of life. As difficult as it may seem, what it means to have a STD or STI needs to be talked about. Exploring your feelings now will be better for your emotional and physical health in the long run. You can talk about it with someone in your life who is nonjudgmental, mature and caring, such as a close friend, parents, confidant, partner or a therapist. In addition, it is also very important to understand it from the medical perspective; this is necessary to protect your health in the future.

This topic brings up so many issues, I will make sure to write more on this very soon. 

Thank you for reading.

Rethinking How and Why You Drink

I’ve tried to define risky or heavy drinking in a prior post. Naturally, a post on why one may want to consider cutting back or drink moderately follows.

First, I’d like to distinguish alcoholism from alcohol abuse,
i.e. risky/heavy drinking, by making the distinction between physical dependence on alcohol from psychological dependence.

I am primarily concerned with psychological dependence and its relationship to emotional health. 

The following are the most common reasons/beliefs why people say they drink:

1. Alcohol makes me feel less shy and more social
2. Drinking alcohol makes socializing more fun
3. I am more interesting and fun to be with when I am drinking
4. I am more myself when I am drinking
5. Alcohol relaxes me
6. Alcohol unwinds me from stresses of life
7. Drinking makes me forget my troubles
8. I am more creative when I am drinking

These reasons, for the most part, are valid and supported by the fact that alcohol has been around just as long as we have. There is no denying that ethyl alcohol, the active chemical compound in alcohol, does relax the brain and body, initially.

One possible explanation for how drinking becomes problematic maybe because of habits. Once we hold an idea of ourselves to be true – I am more social and friendly after a couple of beers or alcohol helps me to relax – the repetition of the behavior, or the habit, reinforces the belief which first initiated the behavior. We begin to believe that drinking alcohol is the ONLY way we can be relaxed, be more social and have fun in a social setting. In a sense, we become trapped by the beliefs we have about ourselves. We become the person who we believe we are.

But we can’t be sure this is true, even though it may have been true in high school or college when we first started drinking. But, we can discover new parts of ourselves by doing the same things differently or trying new things.

By questioning established beliefs or behaviors and trying new ideas, we learn new aspects of our personalities, expanding our idea of who we are. As our self-image or self-concept expands, so does our self-esteem, which makes incorporating new ways of thinking and behaving easier.

Practical application of this theory to problem drinking would be to see how it feels to go out and not drink or limit how much you drink so that you don’t go beyond the threshold where alcohol influences your ability to make decisions. 

I recommend to my clients who have identified heavy drinking as a problem to abstain from alcohol for 30 days. During these 30 days, they are encouraged to think deeply about their relationship to alcohol and decide how they might go about changing it. They may decide to stop drinking all together or try to moderate their drinking.

This period of self reflection is not an easy one. Many people will give up, because it would mean dealing with their anxiety and depression. It is demanding work, and change does not take place over night.

To be continued...

Sort of a Film Review: Silver Linings Playbook

http://www.kentuckytheater.com

Initially, I was skeptical about Silver Linings Playbook, but it disabused me of the misconception that all rom-coms are silly affairs in which an attractive young woman and man fall in love after overcoming a series of obstacles. SLP, like other movies of the genre, shows us that the quest for love is universal. Its two protagonists, played by Bradley Cooper and Jennifer Lawrence, are very pretty, as you would expect. I had dismissed Bradley Cooper as an exceptionally good-looking comic actor, and I wasn't familiar with Jennifer Lawrence. However, she won me over as the wounded yet feisty and self-aware young woman; I found her character so intriguing I forgave her being so young, talented and beautiful. And, I gained an appreciation for Bradley Cooper as a man with bipolar disorder just released from a long stay in a psychiatric hospital. His performance did not embarrass; he didn’t simply play “crazy.” Instead, he played a man whose capacity for suffering emotional pain was monumentally greater than most people’s because of the illness. 

As a mental health professional, I appreciated how the film treated mental illness with depth, humour and fairness; I am hoping that it can lift the some of the stigma that keeps people from accessing mental health services. 

These are some of the reasons why I recommend Silver Linings Playbook:

1. By no means should Cooper’s character be mistaken for a clinical case study of bipolar disorder, but it portrayed BD's main features in a believable way. Also, his father's (played by Robert DeNiro) compulsive and superstitious dependence on numbers was a lighthearted look at OCD-like behavior, perhaps to suggest that predisposition to mental illness can be hereditary. 

2. The movie shows that character's bizarre behavior of Bradley Cooper's character did not come about in a vacuum (it's important to note that he did not have delusions or hallucinations, symptoms of psychosis). The distress of catching his wife with another man had triggered his hypersensitivity to a full-blown episode of mania and depression (although we did not see his depressive symptoms). His reaction went above and beyond the "functional range" of emotional response, and, as a result, he was hospitalized. Symptoms of mental illness, especially mood disorders, are extreme (pathological) reactions to life’s inevitable ups and downs, and they are disruptive and upsetting to the sufferer and their family and friends. But, the point is that everyone of us have experienced these symptoms to some degree, because this is what it means to be human. 

3. Medication works. It does not “cure” but, under the care of an able psychiatrist, it can manage and control the symptoms and improve the quality of life for the patient and their family. It enables the patient to work, be in relationships and seek talk therapy to complement the pharmacotherapy, which only addresses brain chemistry. The most effective treatment for mental illness is drug therapy with concurrent psychotherapy. 

4. People diagnosed with mental illness have unique personalities and real lives, and they are capable of great achievements. They are more than their symptoms or diagnosis. One can LIVE with mental illness.

5. Mental health professionals are real people. We have real lives that are sometime messy and have interests outside work that may seem incongruent with what we do professionally. However, I am not a fanatical fan of any sports team.

Sort of a Film Review: Flight

As you may already know the awards season has begun. Usually I am just an avid watcher and not a reviewer, but this year a couple of movies caught my attention, and I thought they related to what I am trying to do here. Here is my two cents on Flight.

Denzel Washington has been nominated for an Oscar for best actor for Flight directed by Robert Zemeckis. Washington's character, Whip Whitaker, is a commercial jet pilot and a functioning alcoholic. Did I get your attention yet? Just the premise alone is compelling! Predictably, things fall apart (literally, in the sky) for our anti-hero – there wouldn’t be a movie otherwise – and the reality of his addiction unfolds in a nightmarish scenario. For this reason, you won’t be seeing Flight as an in-flight entertainment option. The fatal crash/accident is part one of Whip’s hitting bottom, and the second part… Let’s just say there is a Hollywood ending, and he is redeemed.

What is interesting is the portrayal of addiction with its near limitless potential for denial. Even after a broken marriage, loss of his son’s love and respect because of his drinking, and the resulting social isolation (his only friend it seems is his drug dealer), Whip is so blinded by alcoholism’s cycle of shame, guilt and physical dependence, he can’t and won’t see what it has done to him. Unresolved shame and guilt lead to continued use because chemically altering the brain is the easiest way to avoid the painful act of self-reflection. The medicine that numbs uncomfortable thoughts and feelings also happens to be the source of discontent. As it is said there is no free lunch, one way or another there is a price to pay for delaying what is inevitable. To feel at ease with life requires that we take a long, hard look at who we are and come to terms with it, or make changes so that we can live with ourselves. For many who are caught in alcohol and drugs’ dark embrace, until something dramatic happens where they are forced to, they can’t listen or look at themselves. 

What is the lesson from Flight? Listen to yourself and watch for how you feel. Are you unhappy? Are you sad? Are you lonely? Are you tormented by feelings of shame and guilt because of your out-of-control drinking and/or drug use? If you feel that you are partying a bit too much, do something about it, talk to friends or family members, or a professional, before it takes off on its own dangerous course.

What Is Problem Drinking?

What is too much drinking? That depends on whom you ask. Some will say, “I drink every day, but I don’t drink during the day.” And, others say, “The only problem I have is that bars close at four, and I have to stop drinking.” Or, “Just as long as I am able to go to work/school and attend to my life, I can drink just as much as I want.” But, it’s difficult to admit that one feels that they do not have control over something outside themselves. So, until something concrete and negative happens, most people learn to live with the vague anxiety of feeling powerless.

I think many people, including myself, were surprised by this guideline from the National Institute on Alcohol and Alcohol Abuse on problem drinking. By their measure most people I know in New York City between the ages of 20 to 50 are problem or binge drinkers. But, most of these people are not alcoholics either. Personally I don’t know anyone who has been to detox or rehab*. I’ve worked as a social worker with many clients who have been in and out of inpatient and outpatient drug and alcohol treatment programs, and so I know what alcoholism and addiction looks like. Most of my peers would fall into the problem or habitual drinker category at some point in their lives, but they would not be classified as alcoholics.

So why is habitual, mindless, heavy or risky drinking a problem? With every behavior there is a consequence, and consequences of unchecked alcohol consumption are very real and can pervade every aspect of life. Common issues are: vague discontent and unhappiness (depression, maybe not in the clinical sense); poor health due to bad diet and excessive alcohol, smoking while drinking and lack of exercise; frequent hangovers; being late or missing work or school; regret over one’s behavior while drunk – being excessively emotional, aggressive or sexual; use of other drugs such as cocaine, further lowering inhibition leading to poor decision making; fighting with partners about drinking or other problems caused by drinking.

As a result of these and other reasons, problem drinkers try to cut back or stop but often without success. Because problem drinkers have difficulty controlling alcohol intake, they may intend to have just a drink or two, but after the two they find themselves not wanting or able to stop. And, happy hour becomes an all-night drinking session or binge. And for problem drinkers, drinking happens most nights of the week, although not heavily every time. 

To be continued…

*Detox takes place in a hospital or medical setting for the duration of a short week. For severe alcoholics medically supervised alcohol withdrawal is necessary as seizures and other serious complications may occur when a body, long immune to the presence of alcohol, is suddenly without it. For this reason, anti-anxiety medications, such as Xanax, Valium and Librium, are often prescribed. The singer Amy Winehouse’s death was probably a result of unsupervised withdrawal.

Rehabs are usually 28 days long, although depending on severity and finances stays can be longer. I’ve worked in a facility that wasn’t much different from jail; many of its clients, mostly former heroine addicts, were mandated to drug treatment in lieu of serving yet another stint in jail for drug-related charges. Most of these clients were Medicaid eligible and stayed anywhere between three months to two years. Private insurance does provide inpatient substance abuse treatment, but they ususally restrict the duration of treatment to 28 days. However, if you are financially able, treatment options are plentiful. After the initial medically supervised withdrawal (what happens in a detox) a treatment team addresses the psychological aspect of addiction. Through group and individual therapy long exploration into the how’s and why's of addiction, in addition to strategies to prevent relapse, are explored These programs are designed to prepare for maintaining abstinence – a life of sobriety. Ideally, this would be just the beginning of psychotherapy, which should continue post-rehab.